Typhoid Fever Complicated by Intestinal Perforation: A Persisting Fatal Disease Requiring Surgical Management

Intestinal perforation is one of the most dangerous complications of typhoid fever and demands urgent hospitalization, diagnosis, and surgical management to reduce morbidity and prevent mortality. Here, we report a case of typhoidal intestinal perforation in a 19 year-old young man detected by passive surveillance during a cluster-randomized trial with Vi-tetanus toxoid conjugate vaccine (Typhoid Vaccine Acceleration Consortium: TyVAC) in an urban slum area in Mirpur, Dhaka, Bangladesh. The patient presented with a high-grade fever, lower abdominal pain, and vomiting and was admitted to a healthcare facility. Physical examination and preoperative investigations of the patient suggested a presumptive diagnosis of intestinal perforation, and the patient was transferred to a tertiary-level hospital for surgical management. A positive blood culture, intraoperative findings, and histopathology of an intestinal biopsy confirmed ileal perforation due to typhoid fever. This case report highlights the need for prompt diagnosis and appropriate pre- and postoperative management of patients who appear with the symptoms of typhoidal intestinal perforation. This report further demonstrates the importance of systematic surveillance and proper evaluation to determine the true incidence rate of typhoid fever and intestinal perforation in Bangladesh.

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Intestinal Perforation in Typhoid Fever; Its Prognosis and Treatment

Boston Medical and Surgical Journal ◽

10.1056/nejm189110011251405 ◽

1891 ◽

Vol 125 (14) ◽

pp. 346-348

Author(s):

REGINALD H. FITZ

Keyword(s):

Typhoid Fever ◽

Intestinal Perforation

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Fatal typhoid intestinal perforation in post tubal ligation death with an alleged medical negligence: a rare case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180209 ◽

2018 ◽

Vol 7 (2) ◽

pp. 755

Author(s):

Pankaj Suresh Ghormade ◽

Ajay Narmadaprasad Keoliya

Keyword(s):

Typhoid Fever ◽

Intestinal Perforation ◽

Rare Case ◽

Tubal Ligation ◽

Medical Negligence ◽

Free Perforation ◽

Ileal Perforation ◽

Rare Case Report ◽

History Of ◽

Difficult Challenge

Worldwide tubal sterilization is commonly used procedure for family planning method. Tubal ligation by minilaparotomy under local anaesthesia is most commonly used method of female sterilization in India. The death rate after tubal sterilizations is 72/100000 for all procedures and mainly due to general anaesthesia or vascular injuries. Iatrogenic injury to bowel can occur in minilaparotomy tubal ligations if there are dense adhesions of intestines or history of previous surgery. In the present case of interval post tubal ligation by minilaparotomy, fatal ileal perforation due to typhoid fever was detected on autopsy which was confirmed after complete histological and lab investigations. Atypical complications of typhoid fever were also noted. In developing countries, typhoid fever is the leading cause of non-traumatic free perforation of intestine and its incidence ranges from 0.9% to 39%, with a high mortality rate. This is rare case of an alleged medical negligence after surgery; in which deciding factor was cause of intestinal perforation i.e. iatrogenic or natural and it posed a difficult challenge.

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Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi

Clinical Infectious Diseases ◽

10.1093/cid/ciaa405 ◽

2020 ◽

Vol 71 (Supplement_2) ◽

pp. S96-S101

Author(s):

Franziska Olgemoeller ◽

Jonathan J Waluza ◽

Dalitso Zeka ◽

Jillian S Gauld ◽

Peter J Diggle ◽

...

Keyword(s):

Typhoid Fever ◽

Low Income ◽

Intestinal Perforation ◽

Bowel Perforation ◽

Temporal Trends ◽

Case Fatality ◽

Salmonella Typhi ◽

Outcome Data ◽

Morbidity And Mortality ◽

Abdominal Viscus

Abstract Background Typhoid fever remains a major source of morbidity and mortality in low-income settings. Its most feared complication is intestinal perforation. However, due to the paucity of diagnostic facilities in typhoid-endemic settings, including microbiology, histopathology, and radiology, the etiology of intestinal perforation is frequently assumed but rarely confirmed. This poses a challenge for accurately estimating burden of disease. Methods We recruited a prospective cohort of patients with confirmed intestinal perforation in 2016 and performed enhanced microbiological investigations (blood and tissue culture, plus tissue polymerase chain reaction [PCR] for Salmonella Typhi). In addition, we used a Poisson generalized linear model to estimate excess perforations attributed to the typhoid epidemic, using temporal trends in S. Typhi bloodstream infection and perforated abdominal viscus at Queen Elizabeth Central Hospital from 2008–2017. Results We recruited 23 patients with intraoperative findings consistent with intestinal perforation. 50% (11/22) of patients recruited were culture or PCR positive for S. Typhi. Case fatality rate from typhoid-associated intestinal perforation was substantial at 18% (2/11). Our statistical model estimates that culture-confirmed cases of typhoid fever lead to an excess of 0.046 perforations per clinical typhoid fever case (95% CI, .03–.06). We therefore estimate that typhoid fever accounts for 43% of all bowel perforation during the period of enhanced surveillance. Conclusions The morbidity and mortality associated with typhoid abdominal perforations are high. By placing clinical outcome data from a cohort in the context of longitudinal surgical registers and bacteremia data, we describe a valuable approach to adjusting estimates of the burden of typhoid fever.

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